NARCAN TOOLKIT Table of Contents

I. SUMMARY

II. BACKGROUND

III. RATIONALE

IV. Medical Directives

V. SUGGUSTED TIMELINE

VI. NALOXONE AVAILABILITY

VII. PRESCRIPTION AND PHARMACY ACCESS TO NARCAN

RESCUE KITS

VIII. COST OF NARCAN

IX. Administration of Nasal Naloxone to Individuals

Experiencing overdose

X. EXAMPLES OF STANDING ORDERS

XI. LETTER TO SCHOOL COMMITTEE

XII. POLICY AND PROCEDURE

XIII. OVERDOSE RESPONSE TRAINING POWERPOINT

XIV. BUREAU OF SUBSTANCE ABUSE SERVICES (BSAS),

DIRECTORY

XV. References

******************************************************

Lisa Larsen Cross BSN, RN, Northeast Regional Consultant

Patricia McCaffrey, MSN, BSN, RN, Director of Nursing, Waltham Public Schools

Rationale for Naloxone use in School Setting per NASN Position Statement, 6/2015.

I. SUMMARY

“It is the position of the National Association of School Nurses (NASN) that the safe and effective

management of opioid pain reliever (OPR)-related overdose in schools be incorporated into the school

emergency preparedness and response plan. The registered professional school nurse (hereinafter referred

to as school nurse) provides leadership in all phases of emergency preparedness and response. When

emergencies happen, including drug-related emergencies, managing incidents at school is vital to positive

outcomes. The school nurse is an essential part of the school team responsible for developing emergency

response procedures. School nurses in this role should facilitate access to naloxone for the management of

OPR-related overdose in the school setting.

II. BACKGROUND

Deaths from prescription painkillers (opioid or narcotic pain relievers) have reached epidemic levels in the

past decade according to the Centers for Disease Control and Prevention (CDC) (2014a). A crucial

mitigating factor involves the nonmedical use of prescription painkillers—using drugs without a

prescription or using drugs to obtain the "high" they produce. In 2010, the CDC stated about 12 million

Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year (CDC,

2014a). The 2013 Partnership Attitude Tracking Study (PATS) stated almost one in four teens (23 percent)

reported abusing or misusing a prescription drug at least once in his or her lifetime, and one in six (16

percent) reported doing so within the past year (Feliz, 2014). According to the Substance Abuse and Mental

Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health in 2013, there were

2.2 million adolescents ages 12 to 17 who were current illicit drug users (SAMHSA, 2014). Given the

magnitude of the problem, in 2014 the CDC added OPR overdose prevention to its list of top five public

health challenges (CDC, 2014b).

III. RATIONALE

Schools should be responsible for anticipating and preparing to respond to a variety of emergencies (Doyle,

2013). The school nurse is often the first health professional who responds to an emergency in the school

setting. The school nurse possesses the education and knowledge to identify emergent situations, manage

the emergency until relieved by emergency medical services (EMS) personnel, communicate the

assessment and interventions to EMS personnel, and follow up with the healthcare provider. Harm

reduction approaches to OPR overdose include expanding access to naloxone, an opioid overdose antidote,

which can prevent overdose deaths by reversing life-threatening respiratory depression. When administered

quickly and effectively, naloxone has the potential to immediately restore breathing to a victim

experiencing an opioid overdose (Hardesty, 2014).

Naloxone saves lives and can be the first step towards OPR abuse recovery. It provides an opportunity for

families to have a second chance with their loved ones by getting them into an appropriate treatment

regimen (Lagoy, 2014). Ensuring ready access to naloxone is one of the SAMSHA’s five strategic

approaches to prevent overdose deaths (SAMHSA, 2013). ‘

IV. Medical Directives: DPH

Administration of Nasal Naloxone to Individuals Experiencing

Life-Threatening Opiate Overdoses

The Massachusetts Department of Public Health (DPH) School Health Unit recommends

that each school district or private school have a written protocol, signed by the school

physician, authorizing the school nurse to administer nasal naloxone to individuals who

experience a life threatening opiate overdose in the school setting. Stock supplies of

nasal naloxone should be maintained by the school nurse for this purpose.

Per MGL C. 94C §19(d), effective August 2, 2012, nasal naloxone may be prescribed

and dispensed to a person in a position to assist a person at risk of experiencing an opiate-

related overdose. Accordingly, all nurses in all practice setting, as part of their

professional responsibility, may teach individuals to administer nasal naloxone.

In accordance with the proposal of the school nurse and school physician, the local

School Committee or Board of Trustees may approve categories of unlicensed school

personnel to whom the school nurse may train in the responsibility for administration of

nasal naloxone in the school setting to individuals with life-threatening opiate overdose

events. The training program is managed, with full decision-making authority, by the

school nurse leader in consultation with the school physician. The school nurse leader or

school nurses designated by the nurse leader should select the individuals authorized to

administer nasal naloxone.

The school personnel authorized to administer nasal naloxone are trained and tested for

competency by the designated school nurse leader or school nurses designated by the

nurse leader, in accordance with standards and a curriculum established by the

Department and as provided for in regulations at 244 CMR 3.00 which state that teaching

is a professional activity which does not constitute delegation. School nurses would be

responsible and accountable for their nursing judgments, actions, and competence related

to teaching of nasal naloxone administration, but not for performance of the activity or

the outcome.

It is recommended that the following protocol for training unlicensed school personnel (if

approved by the School Committee or Board of Trustees) be adhered to:

1. Nasal naloxone should be administered only in accordance with DPH

competencies and trainings.

2. Places where the nasal naloxone is to be stored, should be identified, with the

following consideration of the need for storage:

a. at one or more places where students may be most at risk;

b. in such a manner as to allow rapid access by authorized persons, including

to identified students who are in possession of nasal naloxone; and

c. in a place accessible only to authorized persons. The storage location(s)

should be secure, but not locked during those times when nasal naloxone

is most likely to be administered, as determined by the school nurse.

3. The school nurse leader or school nurses designated by the nurse leader, should

document the training and testing of competency.

4. The school nurse leader or school nurses designated by the nurse leader, should

provide a training review and informational update at least twice a year.

5. The training, at a minimum, should include:

a. procedures for risk reduction;

b. proper use of the nasal naloxone administration kit;

c. requirements for proper storage and security;

d. the need for immediate notification of the local emergency medical

services system (generally 911) and

e. procedure for documentation.

V. SUGGESTED TIMELINE:

Approval from Medical Director and Superintendent; Arrange education and training. If needed, present at

School Committee. Standing orders signed by MD. Training of Naloxone.

VI. NALOXONE AVAILABILITY

It is recommended to check with your local pharmacy. Most pharmacies have standing orders

that can provide you with Naloxone. Other options are Costco, School Health Supply, etc.

VII. Prescription And Pharmacy Access To Naloxone Rescue Kits

http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits

VIII. COST OF NALOXONE

Although the cost is being driven up due to high demand, generally the cost is around $50.00.

IX. Administration of Nasal Naloxone to Individuals Experiencing overdose

OPIATE OVERDOSE | RESPONSE TRAINING VIDEO | NARCAN

https://www.youtube.com/watch?v=Bul_CB_9o-Y

X. EXAMPLE OF STANDING ORDERS:

NEEDHAM PUBLIC SCHOOLS

School Health Services

Needham, Massachusetts 02494

Protocol, Procedures, and Standing Medical Orders for the

ADMINISTRATION OF NALOXONE

Purpose:

Naloxone is an opioid antagonist that is used to reverse the effects of opioids.

Current research has determined that Naloxone administration has been found to prevent death

from opioid overdose, as well as reduce disability and injury from opioid overdoses.

The rapid administration of Naloxone may be life-saving in patients with an overdose due to

opioid use. (Doe-Simpkins, Walley, Epstein, & Moyer, 2009)

Drug: Naloxone (Narcan)

Dose: 2mg initial dose for individuals > 20kg or > 5years of age

Naloxone HCl 1mg/ml, in pre-filled 2ml Luer-Lock needless syringe via intranasal

automizer

Route: Intranasal only

Indication: Registered nurses may administer Naloxone to a person in the event of respiratory

depression, unresponsiveness, or respiratory or cardiac arrest when an overdose from opioid is suspected of

a student, staff member, or visitor. Person is unresponsive, very low respiratory rate or not breathing, low

blood pressure, and there is no response to sternal rub.

Contraindications: diabetic ketoacidosis, electrolyte imbalance, hypothermia, meningitis, apnea, stroke,

subdural hematoma, plan poisoning, toxicity from other drug, allergy to any ingredient in naloxone

Precautions: pregnancy or those who are planning to become pregnant, breast feeding mothers, non

prescription medications, herbal remedies, diet supplements, history of heart disease or substance abuse

PROCEDURE

1. Activate EMS: Call 911. Nurse or designee will call 911 to activate emergency medical service

response

2. Assessment: ABC’s: Airway, Breathing, Circulation.

a. For pulseless individuals, initiate CPR per BCLS guidelines

b. For apnea with pulse: establish airway and begin rescue breathing

c. Check for: foreign body in airway, level of consciousness* or unresponsiveness, very

low respiratory rate or not breathing, no response to sternal rub, respiratory status*

gasping for air while asleep or odd snoring pattern, pale or bluish skin, slow heart-rate,

low blood pressure, no response to sternal rub. Pin point pupils and track marks may be

present, although absence of these findings does not exclude opioid overdose.

d. *Level of consciousness

i. The nurse determines that the person presents with a decrease in level of

consciousness as evidenced by;

difficult to arouse (responds to physical stimuli but does not

communicate or follow commands, may move spontaneously)

unable to arouse (minimal or no response to noxious stimuli, does not

communicate or follow commands)

e. *Respiratory status

i. The nurse determines that the person presents with a depression of respiratory

status as evidenced by;

decrease in respiration rate

if available, interpretation of pulse oximetry measurement

f. Nurse determines need for Naloxone administration

3. Administration: Intranasal administration of Naloxone a. Assess person for contraindications or precautions to Naloxone, per available information

b. Exclusion criteria also includes: nasal trauma or epistaxis

i. Assemble Naloxone vial and intranasal atomizer:

Pop off two yellow caps from the delivery syringe and one red cap

from the Naloxone vial.

Screw the Naloxone vial gently into the delivery syringe.

Screw the mucosal atomizer device onto the top of the syringe.

ii. Spray half (1mg) of the Naloxone in one nostril and the other half (1mg) in the

other nostril for a total of 2 mg.

iii. Continue rescue breathing or BCLS as needed.

iv. If no response, an additional second dose/vial may be administered after 3- 5

minutes.

v. Naloxone duration of action is 30-90 minutes.

vi. Transport to nearest hospital via EMS

Storage: Store at 59 o to 86

o F, away from direct sunlight

Possible Side Effects: Acute withdrawal symptoms, change in mood, increased sweating, nervousness,

agitation, restlessness, tremor, hyperventilation, nausea, vomiting, diarrhea, abdominal

cramping, muscle or bone pain, tearing of eyes, rhinorrhea, craving of opioid, rash hives,

itching, swelling of face, lips, or tongue, dizziness, fast heartbeat, headache, flushing,

sudden chest pain

Nursing Considerations: Withdrawal can be unpleasant; Person may just breath but not have full arousal

or

person may need continued rescue breathing and support.

Documentation: Record encounter in student’s school health record and on incident report

for student, employee, or visitor, as applicable

Documentation must include patient presentation, route (intranasal), and dose that

was administered as well as the patient’s response to the Naloxone

administration.

Alan Stern, M.D., School Physician’s signature: ___________________ Date ______________

Effective date: August 2015- August 2016

Reference

Doe-Simkins, M., Walley, A., Epstein, A. & Moyer, Peter. (2009). Saved by the nose: Bystander-

administered intranasal naloxone hydrochloride for opioid overdose. American Journal of Public

Health, 99 (5), 788-791.

XII: Letter to school committee:

PP from Hudson Public School available for School Committee presentation

In order to recognize and respond to a potential life threatening opioid overdose as part of the

Saving Lives-A Case for Stocking Narcan in our

School Health Offices

Presentation to School Committee

September 21, 2015

Lee Waingortin, BSN, RN, NCSN, CCM

Director of Nursing, Hudson Public Schools

XII. POLICY AND PROCEDURE

Braintree Public Schools

Policy and Procedures for School Nurse Management of Potential Life Threatening Opioid Overdose

Program

MDPH opioid overdose prevention pilot program, the Braintree Public Schools will maintain a system-

wide plan for addressing potential life threatening opioid overdose reaction. This plan shall include:

Building-based general medical emergency plan

The Director of School Nursing Services will have the responsibility for the development and

management of the naloxone administration program in the school setting in accordance with

MDPH protocols.

The school physician will provide oversight to monitor the program and ensure quality

improvement and quality control.

Training per MDPH protocols will be provided for all school nurse responders.

Integration with the local emergency medical services (EMS) system will be included in the

implementation of this program.

Background

It is strongly recommended that school nurses have access to Naloxone medication in the school

setting to ensure its immediate availability to students, staff and building visitors.

Recognizing that fatal and non-fatal overdoses from opioids play an increasing role in the

mortality and morbidity of Massachusetts residents, the Massachusetts Department of Public Health

launched the Overdose Education and Naloxone Distribution (OEND) prevention program using intra-nasal

Narcan (naloxone) in an attempt to reverse this trend. Naloxone is an opioid antagonist which means it

displaces the opioid from receptors in the brain. An overdose occurs because the opioid is on the same

receptor site in the brain that is responsible for breathing. Naloxone usually acts dramatically, allowing

slowed or absent breathing to resume. It is both safe and effective and has no potential for abuse. Naloxone

has been used by paramedics in ambulances and by emergency room clinicians for decades. While not a

controlled substance, naloxone is what is known as a “scheduled” drug and therefore does require a

prescription.

The Department of Public Health is operating a naloxone distribution program as a pilot program in

accordance with M.G.L. c. 94C and DPH/Drug Control Program regulations at 105 CMR 700.000. The

distribution of naloxone by approved trainers is authorized by the Department of Public Health and the

standing orders issued by the Medical Director of the naloxone pilot.

What are Opioids

Opioids are chemicals that are either derived from the opium poppy or are synthetically

manufactured by pharmaceutical companies. Whether synthetic or naturally occurring, opioids all act in

similar ways at specific sites in the body. They are depressants, and slow down the central nervous system.

At high levels, opioids reduce consciousness and decrease breathing (respiratory depression). Opioids

attach to specific receptors in the brain, spinal cord, and gastrointestinal tract and block the transmission of

pain messages. They induce euphoria and users generally report feeling warm, drowsy, and content.

Opioids relieve stress and discomfort by creating a relaxed detachment from pain, desires, and activity.

They also cause slow heart rate, constipation, a widening of blood vessels, and decrease the natural drive to

breathe.

Severe Opioid Reaction (Overdose)

Description: An overdose occurs when the body has more drugs in its system than it can handle,

resulting in potentially life threatening dysfunction. People can overdose on many different substances

including other drugs or alcohol. During an opioid overdose there are so many opioids or a combination of

opioids and other drugs in the body that the victim becomes unresponsive to stimulation and/or breathing

becomes inadequate. Those experiencing an overdose become unresponsive, or unconscious, because

opioids fit into specific brain receptors that are responsible for breathing. When the body does not get

enough oxygen, lips and fingers turn blue. These are the signs that an overdose is taking place. A lack of

oxygen eventually affects other vital organs including the heart and brain, leading to unconsciousness,

coma, and then death.

With opioid overdoses, the difference between surviving and dying depends on breathing and oxygen.

Fortunately, opioid overdose is rarely instantaneous; people slowly stop breathing after the drug was used.

There is usually time to intervene between when an overdose starts and a victim dies. Furthermore, not all

overdoses are fatal. Without any intervention, some overdose victims may become unresponsive with

slowed breathing, but will still take in enough oxygen to survive and wake up.

Signs and Symptoms of Opioid Overdose:

Blue skin tinge- usually lips and fingertips show first

Body is very limp

Face is very pale

Pulse (heartbeat) is slow, erratic or not there at all

Throwing up

Passing out

Choking sounds or a gurgling/snoring noise

Breathing is very slow, irregular or has stopped

Unresponsive

Assessing for Responsiveness and Breathing

In order to determine if the individual is experiencing an overdose, the most important things to consider

are presence of breathing and responsiveness to stimulation. There are some relatively harmless ways to

stimulate a person. These strategies are:

Yelling their name

Rubbing knuckles over either the upper lip or up and down the front of the rib cage

called a sternal rub

If an individual responds to these stimuli, they may not be experiencing an overdose at that time. It is best

to stay with the person, to make sure the person wakes up and is ok. It is possible that the person could

become unresponsive and require further assistance.

Continued attempts at stimulation will waste valuable time in helping the individual breathe.

Responding to an Opioid Overdose:

Call 911 to get help

Perform rescue breathing to provide oxygen

Administer Naloxone

Stay with the person until help arrives

Individuals who overdose can die because they choke on their own vomit (aspiration). This can be avoided

by putting the individual in the recovery position. The recovery position is when you lay the person on his

or her side, his or her body supported by a bent knee, with his or her face turned to the side. This position

decreases the chances of the individual choking on his or her vomit. If you have to leave the person at all,

even for a minute to phone 911, make sure you put them in the recovery position.

Procedures:

The School Nurse will respond to any member of the school community when on school property

with a life threatening opioid overdose in the school setting. The management of a Life Threatening

Opioid Overdose takes a multidisciplinary approach of collaboration between school community,

emergency responders, and law enforcement officers. Awareness, prevention and emergency preparedness

are crucial elements in the management of a person with a potential Life Threatening Opioid Overdose.

School Nurse Responsibilities

The school nurse is the key resource for medical direction, assessment and response to a potential Life

Threatening Opioid Overdose. The school nurse MUST be contacted as soon as a potential Opioid

overdose is identified.

Call 911

It is important to report to the dispatcher if the victim’s breathing has slowed or

stopped, he or she is unresponsive, and the exact location of the individual. If

Naloxone was given and if it did/did not work, this is important information to tell

the dispatcher.

Perform rescue breathing

For a person who is not breathing, rescue breathing is an important step in

preventing an overdose death. When someone has stopped breathing and is

unresponsive, rescue breathing should be done as soon as possible because it is the

quickest way to get oxygen into the body. Steps for rescue breathing are:

1. Place the person on his or her back and pinch their nose or use Ambu

bag to administer rescue breaths

2. Tilt chin up to open the airway. Check to see if there is anything

in the mouth blocking the airway. If so, remove it.

3. Give 2 slow breaths.

4. Blow enough air into the lungs to make the chest rise.

5. Assess each breath to ensure the chest is rising and

falling. If it doesn’t work, tilt the head back more.

6. Breath again every 5-6 seconds

Administer Nasal Naloxone (Narcan)

Naloxone is a medication that reverses overdose from heroin or other opioids.

Naloxone is the generic name for Narcan.

Nasal Naloxone may work immediately, but can take up to 8 minutes to have an effect.

The effect of the naloxone will last for about 30 to 90 minutes in the body. Because most

opioids last longer than 30 to 90 minutes, the naloxone may wear off before the

effects of the opioids wear off and the person could go into an overdose again. This

depends on several things, including:

the quantity and purity of opioids used

the presence of other drugs or alcohol

the effectiveness of the liver to filter out the drugs

if the victim uses opioids again once the naloxone is administered

In response to these issues, the nasal naloxone rescue kits include 2 doses. Naloxone

administration may be repeated without harm if the person overdoses after the first dose

wears off. Due to the complex nature of each of these medical emergencies, it further

highlights the necessity of calling 911.

Bleeding from the nose

If the person overdosing has substantial nasal bleeding, naloxone may not work because the blood will

interfere with absorption of the naloxone. Call for help and rescue breathe.

How to assemble nasal naloxone device and administer nasal naloxone:

1. Pop off two yellow caps and one red (or purple) cap.

2. Hold spray device and screw it onto the top of the plastic delivery device.

3. Screw medicine gently into delivery device

4. Administering Narcan:

Spray half of the naloxone (1 ml) up one side of the nose and half (1 ml) up the other side of the nose.

If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing

while waiting for the naloxone to take effect. If there is no change in 3-5 minutes, administer another

dose of naloxone (use another box) and continue rescue breathing until they breathe for themselves

or help arrives.

5. Monitor the victim

Naloxone blocks opioids from acting so it can cause withdrawal symptoms in someone with opioid

tolerance. Therefore, after giving someone naloxone, he or she may feel withdrawal symptoms and want to

use again. It is important that the victim does not use opioids again after receiving naloxone so that an

overdose does not re-occur. If possible, the bystander who administered the naloxone should stay with the

person who overdosed.

Key Points: School Nurse will respond to an opioid overdose

1. Call 911

2. Perform rescue breathing

3. Administer nasal naloxone

4. Place the person in the recovery position

5. Stay with the victim

Storage: Nasal Naloxone Hydrochloride will be kept in the locked medication cabinets in

each school nurses office.

School Nurse yearly Training:

1. Training of Naloxone Administration by (School) Nurses:

A school nurse, as defined by the Massachusetts Department of Elementary and Secondary

Education, may be trained by Massachusetts Department of Public Health (aka "the

Department") approved trainers for the purpose to administer naloxone by nasal

administration in a life-threatening situation when first responders are not immediately

available.

Department planning and implementation: (1) The Department approves policies, curriculum and procedures for training.

(2) In consultation with the prescribing physician, designated school nurses, including

“approved trainers” are trained and tested for competency in accordance with standards and a

curriculum established by the Department.

(3) Approved trainers arrange for trainings of school nurses in local communities, in

accordance with standards and curriculum established by the Department.

(4) The school nurse will document the training and testing of competency, in accordance

with standards and curriculum established by the Department.

(5) The training, at a minimum, will include:

(a) Procedures for risk reduction;

(b) Recognition of the symptoms in an individual with an opiate overdose;

(c) The importance of following the prescribed method of medication

administration;

(d) Proper use of the nasal inhaler method

(e) The requirement to call local emergency services prior to administration, and

(f) Requirements for proper storage and security, notification of appropriate

persons following administration, and record keeping.

(6) The nurse shall maintain and make available upon request by the Department a list of all

licensed individuals trained to administer naloxone by nasal administration if any

(7) All trainings in the administration of naloxone will be done in accordance with prescribed

methods.

(8) Priorities for trainings will be in communities where individuals most at risk have been

identified.

(9) School nurses will submit a report to the Department of Public Health School Health Unit

each time training of naloxone administration is completed.

(10) All other medication administration procedures will hold forth including:

(a) reporting of any medication errors per 105 CMR 210.00

(b) proper disposal of a used naloxone administration delivery system.

Policy Review and Revision

Review and revision of these and procedures shall occur as needed but at least every two years.

September 10, 2015

Registration of Naloxone Training:

Name of Trainer: _____________________________________

Date: _______________________________________________

Location: ____________________________________________

Narcan training evaluation sheet

Informational

Name of Trainee License

(if applicable)

Resources: PUBLICATIONS

NIH - “Drugs Shatter the Myths,” National Institute on Drug Abuse - NIH publication #13-7589, revised

July 2013.

Research Report Series – Heroin publication 14-0165. Revised April 2014.

NASN Position Statement: Naloxone Use in the School Setting: The Role of the SchoolNurse:

http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/

462/ArticleId/854/Naloxone-Use-in-the-School-Setting-The-Role-of-the-School-Nurse-Adopted-June-2015

Bureau of Substance Abuse –http://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/

MDPH:

http://www.mass.gov/eohhs/gov/departments/dph/

http://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/dph-responds-to-opioid-

epidemic.html

MA Substance Abuse Information and Education Helpline:

http://hria.force.com/

http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits

XI. OVERDOSE RESPONSE TRAINING

INSERT – MDPH OVERDOSE POWERPOINT TRAINING

XIII. OVERDOSE RESPONSE TRAINING POWERPOINT

XIV. BUREAU OF SUBSTANCE ABUSE SERVICES (BSAS), DIRECTORY

Bureau of Substance Abuse Services (BSAS) Prevention Unit

DIRECTORY (Effective: MAY 2014)

Massachusetts Department of Public Health Bureau of Substance Abuse Services

250 Washington Street, 3rd Floor Boston, MA 02108-4619

Phone: (617) 624-5111 Fax: (617) 624-5185

K:\Prevention\2014 MDPH-BSAS (Prevention Unit) Directory_MAY2014.pdf

XV. References

Bureau of Substance Abuse –http://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/

MDPH:

http://www.mass.gov/eohhs/gov/departments/dph/

http://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/dph-responds-to-opioid-

epidemic.html

MA Substance Abuse Information and Education Helpline:

http://hria.force.com/

http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits https://www.youtube.com/watch?v=Uq6AxrEY3Vk&app=desktop https://www.youtube.com/watch?v=Bul_CB_9o-Y